Combination therapy more effective for depression

Between 50% and 75% of people show some improvement on first taking an antidepressant but only about a third completely recover after taking just one drug. Previous research has shown that a combination of drugs can have a better effect and a team of researchers led by Pierre Blier of the University of Ottawa studied the effectiveness of adding mirtazapine to various different antidepressants. Mirtazapine belongs to a different class of drugs to most other antidepressants and is classified as a noradrenergic and specific serotonergic antidepressant (NaSSA). 105 people with major depression received either fluoxetine on its own, or mirtazapine combined with fluoxetine, venlafaxine or bupropion. The recovery rates were 25% for fluoxetine, 52% for mirtazapine and fluoxetine, 58% for mirtazapine and venlafaxine and 46% for mirtazapine and bupropion. There were no extra side effects from using a combination of different drugs.

Blier, Pierre ... [et al] - Combination of antidepressant medications from treatment initiation for major depressive disorder: a double-blind randomized study American Journal of Psychiatry March 2010, 167(3), 281-288

Fluoxetine not effective for autism

Fluoxetine (Prozac) is often prescribed for people with depression, anxiety and obsessive-compulsive disorder but has also been used to treat repetitive behaviour in people with autism. Small-scale studies have shown promising results but trials of a new, low-dose form of the drug, aimed specifically at treating autism in children and adolescents, have proved a disappointment. The study of 158 children, aged between 5 and 17, carried out by researchers in 19 sites across the U.S. compared the fluoxetine to a sugar-pill placebo. Both reduced repetitive behaviours but there was no difference between the two.

You can find out more about this research at

http://www.sciencedaily.com/releases/2009/02/090218135122.htm

Cost-effectiveness of adolescent depression treatment

A study of 439 children in the U.S. looked into the cost-effectiveness of different treatments for adolescent depression. The study compared the effectiveness of fluoxetine alone, fluoxetine in conjunction with cognitive behaviour therapy (CBT) and CBT alone. The researchers found that CBT and fluoxetine produced the greatest improvement but that it was five times more expensive per quality-adjusted life year* than fluoxetine alone. After 12-weeks CBT 'was neither an effective nor cost-effective option'.

Domino, Marisa Elena ... [et al] - Cost-effectiveness of treatments for adolescent depression: results from TADS American Journal of Psychiatry May 2008, 165(5), 588-596

*for a definition of quality-adjusted life years see

http://en.wikipedia.org/wiki/Quality-adjusted_life_years

Fluoxetine and relapse prevention in childhood depression

Major depressive disorder is a serious problem among young people with between 2-8% of children and adolescents affected. Young people with depression often have significant impairments in relationships, school and work and are at an increased risk for substance abuse, attempted and completed suicide and depression in adulthood. As many as 50-75% of children with major depression have recurrent episodes with recurrence most often occuring within 6-12 months after remission. A U.S. study of 102 children recovering from depression compared a group being given fluoxetine to a group being given a placebo. The group being given fluoxetine were significantly less likely to have a relapse and went longer between relapses than the control group.

Emslie, Graham J. ... [et al] - Fluoxetine versus placebo in preventing relapse of major depression in children and adolescents American Journal of Psychiatry April 2008, 165(4), 459-467